Social 121 Form | East Anglian Dog Tra

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Socialisation 121 Form

Name*

Email*

Phone*

Address*

Your Dog

Dog name*

Breed*

DOB*

Dog

Bitch

Neutered?

Yes

No

If yes, what age?

Any health isues? If yes, please specify

Medical History

Known medical history (especially current problems):

Is your pet currently on any medications or supplements for physical or behavioural issues?

Yes

No

If yes, please list name, dosage and reason for use:

Your home

Type of home (house, flat, etc)

Location (town, estate, remote, etc)

Outside area (small, grass patio, etc)

Degree of access allowed around the home to the dog:

Any other pets?

Please list names and ages (if under 18) of family members who live at home and how you would describe their relationship with your dog:

Early history

Breeder/rescue?

Rescue

Breeder

Age at time:

Situation before owned (kennels, foster, in home, etc)

Current life

Food type and brand:

What physical exercise do your give your dog on a daily basis? Please include on/off lead walks, garden play, toy play, etc.

What mental exercise do you give your dog on a daily basis? (sniffing games, puzzles, kongs, training, etc)

Describe a typical 24 hours in the life of your dog. Include time they get up, any rest, exercise, time alone, bed time, etc:

Sociability

Socialising with dogs history:

Socialising with people history:

I have met:

Dogs at my house

Dogs on lead

Dogs off lead

Lots of dogs

No dogs

When I see other dogs I am:

Shy

Barking

Excited

Growling

Jumping

Lunging

My play style is:

Calm

Barking

Growling

Excited

Running

Wrestling

Chasing

Boisterous

Mouthing/biting

With new people I am:

Shy

Barking

Growling

Excited

Jumping

Training

Attended any other formal training?

Yes

No

Known commands:

Overall aim?

The problem

When did it begin? Approx date:

Where does it occur?

With whom?

Please describe the behaviour you need help with. Where was your dog? Where was everyone in relation to your dog? What was happening before the incident? What did your dog do ? What was your dog's behaviour like before and after the event?

How do you react when the problem occurs?

How frequently does the problem occur?

What has been tried to correct the problem? Please include whether each measure has helped, not made a difference, or made matters worse.

The problem is getting

Better

Worse

No change

Do you suspect any cause?

Any other behavioural issues?

Anything else you want us to know?

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